WPA Working Group on Defining and Managing Autism Spectrum Disorder: spreading knowledge for the next generations of psychiatrists
Authors: Marco O. Bertelli, Annamaria Bianco, Luis Salvador‐Carulla, Afzal Javed
Journal: World Psychiatry (2023)

Autism spectrum disorder (ASD) is believed to affect approximately one in every 100 individuals on the planet, across ethnicities and socioeconomic categories1, although information from low- and middle-income countries remains very scarce. Actually, 2.3% of American youngsters have been diagnosed with autism2, a number that has nearly tripled over the previous 20 years. Individuals with ASD show a high co-occurrence of other neurodevelopmental disorders and adjunctive mental health problems. Intellectual disability is report­ed in 35.2% of cases, and borderline intellectual functioning in 23.1%, while only 41.7% have IQ scores in the average or high­er range2. Attention-deficit/hyperactivity dis­order (ADHD) is also quite common, with peaks of 50%3. Adjunctive psychiatric problems have been observed to be up to six times more prevalent than in the general population, and to present differently, particularly in those with poor or no verbal communication abilities who only convey their distress through behavioral manifestations4. Many of these patients lack access to the essential diagnosis and care, which leads to overmedication. Approximately half of people with ASD, particularly those in the low-functioning portion, receive psychotropic drugs4. In about one-third of situations, medications are administered in the absence of a psychiatric diagnosis with the aim to treat problem behaviors, such as aggressive or self-injurious behaviors, and/or without proper follow-up and tapering when feasible5. Significant training gaps for psychiatrists and other mental health professionals have been identified in this area at all levels of the clinical education system, in addition to knowledge, planning and service delivery challenges4. The scientific community's disregard for the mental health of those with low-functioning ASD and/or intellectual disability has not only been unfair, but has also been inappropriate, because the advancement of scientific knowledge in this area may have important implications for the entire neuroscientific field: for instance, the ability to recognize psychiatric symptoms in patients with cognitive and communicative limitations based on observable and behavioral changes from baseline; the understanding of the relationship between early specific cognitive deficits and psychopathological vulnerability; the definition of the grade of adjunctive functional impairment and clinical distress associated with the co-occurrence of psychopathological conditions. Even care models that were initially developed in the field of ASD/intellectual disability, as well as models to address social health issues (such as stigma and labeling) may be now relevant to general psychiatry and other neuroscientific disciplines. The professional training gap and other unmet mental health needs related to ASD are paid prominent attention in the Action Plan 2020-2023 of the WPA Working Group on Defining and Managing ASD. A major objective of this Working Group, which has just been achieved, is the publication of a comprehensive textbook on psychiatric disorders in people with low-functioning ASD and/or intellectual disability, including the most recent research knowledge on the prevalence, risk and etiological factors, clinical features, assessment procedures and tools, diagnostic criteria, treatment and prognosis6. This volume, entitled Textbook of Psychiatry for Intellectual Disability and Autism Spectrum Disorder, has been produced under the aegis of the WPA, and includes 43 chapters written by 116 of the most authoritative experts in the area. It has been edited by M. Bertelli, S. Deb and K. Munir, from the WPA Section on Psychiatry of Intellectual and Developmental Disorders, and A. Hassiotis and L. Salvador-Carulla, outstanding contributors to the WPA activities related to ASD and intellectual disability. The book has been inspired by the will of sharing knowledge and transmitting passion to colleagues, especially young and future colleagues. In fact, it is intended for use by graduate students and trainees of university faculties, practitioners in clinical disciplines or people having management roles in developmental disability services and education, and to a lesser extent by undergraduate students, parents, attorneys and advocacy groups. This textbook helps clinicians to overcome diagnostic challenges and provide more effective care that is tailored to the specific needs of individuals with ASD and/or intellectual disability. Researchers will find in the volume a summary of current knowledge about an area of psychiatry that is new to them or that intersects their own specialty in the wider field of neurodevelopmental disorders. Beside the production of the textbook, the WPA Working Group on Defining and Managing ASD has started the development of educational materials on key diagnostic features of ASD and co-occurring mental health issues for the WPA Educational Portal7, in connection with a similar initiative of the WPA Working Group on Intellectual Developmental Disorders8. A prominent attention has been paid to the provision of strategies for interdisciplinary approaches, according to the overall WPA Action Plan 2020-20239, 10, and to the promotion of partnerships for joint collaborative work in capacity building among medical students11, young psychiatrists and allied professionals. A further contribution to the improvement of training and practice in the field has been provided through the participation in the development of the World Health Organization (WHO)’s package of rehabilitation interventions for persons with ASD. The importance of spreading knowledge to the next generation of psychiatrists and other mental health professionals has also been the focus of numerous presentations in presidential and special symposia organized by the Working Group at the last years’ WPA World Congresses, and will continue to be highlighted at upcoming WPA events.